Provider Demographics
NPI:1548419013
Name:TAYLOR, PAUL G (RPH, CFTS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RPH, CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SURFSIDE LN
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7464
Mailing Address - Country:US
Mailing Address - Phone:704-664-1999
Mailing Address - Fax:704-664-1999
Practice Address - Street 1:6360 E NC 150 HWY
Practice Address - Street 2:TAYLOR MED PHARMACY/GENERAL STORE
Practice Address - City:SHERRILLS FORD
Practice Address - State:NC
Practice Address - Zip Code:28673-9404
Practice Address - Country:US
Practice Address - Phone:704-483-9150
Practice Address - Fax:704-664-1999
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09264183500000X
NCCFTS0708332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795412Medicaid